Hepatology

Hepatitis C is a silent disease. Eighty-five percent of patients have no symptoms. The most frequent symptom is tiredness, but others include:

• Lack of appetite
• Nausea
• Discomfort over the liver area
• Itching in advanced cases
• Yellow discoloration of the eyes and skin, a condition called jaundice or icterus (early in the disease).

Blood tests are necessary to detect the presence of an antibody against Hepatitis C (HCV-AB). A Liver Biopsy is not necessary for diagnosis, but may be used as a guide to treatment.

Many patients with Hepatitis C can live for years and not even know that they have the disease. However, after acquiring the disease, about one in five patients (20%) develop Cirrhosis, an advanced form of liver disease. It causes the liver to become unable to carry out its many vital functions.

Cirrhosis patients are at risk of developing liver failure, characterized by:

• Swelling of the abdomen and feet
• Jaundice
• Mental confusion
• Bleeding tendencies
• Kidney failure
• Vulnerability to infection
• Possible development of liver cancer

The purpose of medical treatment is to clear the infection and to prevent or reduce complications.

Two drugs are available:

• Peginterferon - an injection given by the patient himself/herself once a week
• Ribavirin - capsules taken every day by mouth

This drug combination is given for 6 to 12 months and is effective in making the Hepatitis virus disappear from the blood in about 5—8 out of 10 patients. Patients with genotype 1 may require treatment for at least one year, while patients with genotypes 2 or 3 may require a shorter course of treatment (6 months).

Peginterferon side effects that may occur:

• Flu-like symptoms (headache, fever, nausea, vomiting, muscle aches and joint pains)
• Depression
• Impaired concentration, irritability and emotional instability
• Susceptibility to infection
• Anemia
• Bleeding tendencies
• Difficulty sleeping
• Partial hair loss in rare instances
• Skin rash
• Adverse effects on blood sugar levels in diabetic patients
• Suppression of the bone marrow resulting in reduced white blood cells and platelets

Ribavirin may also have adverse effects, the most serious being destruction of the red blood cells, which causes anemia.

It is recommended that we not treat patients with:

• Advanced liver failure
• Renal failure
• Uncontrolled depression
• Suicidal and/or homicidal thoughts

Patients with uncontrolled diabetes or active drug or alcohol abuse must first have these conditions under control before treatment can be started. If you choose to not be treated or your doctor does not think you should be treated, it is very important to make sure that you are seeing a LIVER SPECIALIST regularly to make sure that your liver disease is not getting worse and that you do not develop liver cancer.

It is best to avoid all alcoholic beverages, including beer and wine. Alcohol is a poison that damages the liver and increases the number of Hepatitis C viruses. The combination of alcohol consumption and Hepatitis C not only hastens the development of Cirrhosis and liver failure, but also greatly increases the risk of liver cancer. Moreover, alcohol makes the treatment of Hepatitis C less effective. Avoiding alcohol gives the liver a better chance to heal.

The patient with uncomplicated Hepatitis C should eat a balanced diet. There is no special diet for the management of this condition. However, if the patient is overweight, weight reduction is important. Obesity may be associated with increased deposits of fat in the liver that may eventually cause liver damage. Patients with Hepatitis C who already have liver failure may require special diets.

The most commonly used alternative medicine is Milk Thistle. The active component in Milk Thistle, silymarin, is said to protect the liver from damage.

However, there is conflicting scientific data regarding its benefits. While the use of some herbal preparations may be advantageous, their benefits remain to be proven. They may also lead to toxic effects.

Until the benefit of any of the herbal medications has been clearly demonstrated by strict scientific methods, their use cannot be recommended.

There is no available vaccine for protection against Hepatitis C. However, it is very important for patients with Hepatitis C and other types of liver disease to receive vaccines against Hepatitis A and Hepatitis B. Ask your doctor if these vaccines are necessary for you.

Hepatitis C is a viral infection of the liver that is usually acquired through exposure to infected blood or blood products. You can have this infection for years without knowing it. The most common way of getting Hepatitis C is by intravenous drug use.

Other ways include:

• Inhalation (snorting) drugs such as heroin and cocaine
• Hemodialysis
• Blood transfusion before 1992
• Needle stick injury
• Tattoos
• Sexual contact with someone with the above risk factors

There is very low risk of Hepatitis C transmission from mother to baby.

1. To avoid spreading the disease you:
   1. Should not donate blood
   2. Should not share a razor; toothbrush or nail clippers
   3. Should practice safe sex with a condom
2. To avoid making Hepatitis C worse or more difficult to treat, you should AVOID ALCOHOL.
3. You should have your spouse, sex partner and/or long-term household contacts tested for Hepatitis C. Casual contacts need not be tested.
4. Ask your physician if you need to be vaccinated against Hepatitis A and/or Hepatitis B.
5. Even if you are not treated, you should be seen regularly by a liver specialist to monitor the state or progress of the disease.

In a relatively short time, extensive worldwide research on Hepatitis C has led to a greater understanding and better treatment of the disease. The present treatment is more effective than five or so years ago, but we hope to soon have treatments that are even more effective with fewer side effects in the near future.